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Prognostic Utility of Non-invasive Left Atrial Stiffness Index in Patients with Heart Failure with Preserved Ejection Fraction: Insights from EASY-HFpEF study

Tomonori Takahashi, MD, PhD1, Kenya Kusunose, MD, PhD2, Shohei Kikuchi, MD, PhD3, Noriaki Iwahashi, MD, PhD4, Yoshiharu Kinugasa, MD, PhD5, Kaoru Dohi, MD, PhD6, Hiroyuki Takase, MD, PhD7, Katsuji Inoue, MD, PhD8, Takahiro Okumura, MD, PhD9, Shuichi Kitada, MD, PhD3, Yoshihiro Seo, MD, PhD3, Masataka Sata, MD, PhD1, Nobuyuki Ohte, MD, PhD3, on behalf of Easy HFpEF Investigators

1Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan

2Department of Cardiovascular Medicine, Nephrology, and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.

3Department of Cardiology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan

4Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan

5Department of Cardiovascular Medicine and Endocrinology and Metabolism, Faculty of Medicine, Tottori University, Yonago, Japan

6Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan

7Department of Internal Medicine, Enshu Hospital, Hamamatsu, Japan

8Department of Community Emergency Medicine, Ehime University Graduate School of Medicine, Yawatahama, Japan

9Department of Cardiology, Graduate School of Medicine, Nagoya University, Nagoya, Japan

Background

It is known that an increase left atrial stiffness is associated with poor prognosis in patients with heart failure with preserved ejection fraction (HFpEF).

Purpose

We evaluated the predictive utility of non-invasive left atrial stiffness index (LASI) in HFpEF patients, comparing it to other clinical prognostic indicators.

Methods

Patients were recruited from the EASY-HFpEF study, a multicenter prospective observational cohort study in Japan involving patients hospitalized with acute decompensated heart failure and a left ventricular ejection fraction of >40%. Among the patients in the study, those with registered echocardiographic image data of sufficient quality were analyzed for left atrial strain. The LASI was calculated as the ratio of E/e’ to the left atrial reservoir strain. The primary endpoint was a composite outcome of all-cause death and readmission due to heart failure during the 2-year follow-up period.

Results

We analyzed 95 patients, with a median age of 75 years and including 41% female patients. LASI was associated with an increased risk of composite outcome (adjusted HR 1.10 [95%CI; 1.04-1.17, P=0.001] per 0.1 increase). LASI was non-inferior in predictive ability compared to predictors such as B-type natriuretic peptide (BNP) and H2FPEF score. (AUCLASI=0.79, AUCBNP=0.80 [vs.AUCLASI, P=0.775], AUCH2FPEF =0.75 [vs.AUCLASI, P=0.342]) (Figure 1). The addition of LASI significantly improved the prognostic power of a model containing BNP and H2FPEF score (model of BNP+H2FPEF score, χ2=29.3; model of BNP+H2FPEF+LASI, χ2=40.5, P=0.004) (Figure 2).

Conclusion

Non-invasive LASI in HFpEF patients is associated with increased risks of all-cause mortality and heart failure readmission, its potential utility in predicting these adverse events.